• The Journal of the Korean bone and joint tumor society
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• v.8 no.3
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• pp.96-105
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• 2002

Purpose: The purpose of this study was to assess the oncologic results and functional outcomes of limb salvage surgery performed in patients of primary bone tumors of the shoulder girdle. Materials and Methods: Twenty-nine patients who underwent limb sparing resection for shoulder girdle neoplasm between 1982 and 2001 were analyzed. Follow up periods averaged 7 years and 1 month. Mean age of the patients was 35 (11~71) years. There were 14 males and 15 females. Primary malignant bone tumors of shoulder girdle (proximal humerus 21, scapula 3, both 1) were 23 cases; osteosarcomas 7, chondrosarcoma 14, parosteal osteosarcoma 1, hemangioendothelioma 1, and giant cell tumor of proximal humerus were 6 cases. Limb salvage surgery was performed by curettage and cementing in 7 patients, by cement molding arthroplasty in 10 patients, and by tumor prosthesis in 7 patients, by other method such as resection only, bone graft, arthrodesis in 5 patients. The Musculoskeletal Tumor Society functional rating system was used to assess functional outcomes. Results: One osteosarcoma and 2 chondrosarcoma patients died, and the survival of the salvaged limb was 88.6% at the final follow-up. There were 6 local recurrences, 2 lung metastases, 2 local recurrences and lung metastases. The functional outcome was 80%. There was statistically significant difference of functional results among the patients treated by cement filling (86%), cement molding arthroplasty and IM nailing (71%), and tumor prosthesis (83%). (p=0.034) There were three complications including 1 radial nerve palsy and 1 axillary nerve palsy, and 1 wound infection. Dislodgement of vascularized fibular graft in one patient was treated by internal fixation. Conclusion: Limb salvage surgery seems to be useful method to treat bone tumors of the shoulder girdle.

• The Journal of the Korean bone and joint tumor society
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• v.19 no.2
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• pp.56-63
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• 2013

Purpose: This study was performed to evaluate the efficiency of demineralized bone matrix (DBM, Genesis$^{(R)}$) used for bone defect after operative traetment of benign bone tumors by clinical and radiological methods. Materials and Methods: DBM was used to treat bone defect after operative treatment of benign tumor from February 2012 to May 2013. Total 25 benign bone tumor cases (15 males, and 10 females) with mean age of 30.3 were studied. The diagnoses were solitary bone cyst in 9 cases, non ossifying fibroma in 5, fibrous dysplasia in 5, aneurysmal bone cyst in 3 and enchondroma in 3. In categorization by location of tumor, there were 5 cases of distal femur, 4 of proximal tibia, 3 of proximal femur, 3 of proximal humerus, 3 of phalanx, 2 of distal radius, 2 of hip bone, 2 of calcaneus, and 1 of scapula. Autogenous bone was used with DBM in 6 cases, and only DBM used in 19 cases. Mean periods of follow up were 8.7 months (range: 6 to 14 months). Amount of graft resorption and bone formation was observed with compare of post operation radiograph and the difference was shown by percentage. Resorption level was measured by DBM level which could be observed from simple x-ray, and bone formation level by bone trabecular formation level at impaired site. Results: Twenty three cases of total 25 cases showed bone union. In the 23 cases, more than 98% DBM resorption was observed after mean 4.3 months, and more than 98% bone formation was observed after mean 6.9 months. Lesser bone defect sizes showed faster bone formation and it was statistically significant (p=0.036). But other comparative studies on other factors such as, sex, age of patients and combination of autogenous bone were no statistically significant differences in graft resorption and bone formation. And there was no significant complication in periods of follow-up. Conclusion: Demineralized Bone Matrix (Genesis$^{(R)}$) is thought to be useful treatment for bone defect after operative treatment of benign bone tumor, however longer follow-up periods appears to be needed.

• The Journal of the Korean bone and joint tumor society
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• v.1 no.1
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• pp.45-51
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• 1995

The incidence of metastatic bony lesion has been increased recently, with the advanced therapeutic modalities of malignant tumors. The purpose of this study was to evaluate the effectiveness of surgical treatment in impending or established pathologic fractures due to metastasis in extremity. From 1981 to 1992, thirty two patients who had established or impending pathologic fractures in extremity had been treated surgically. The locations of metastasis, were lower extremity in 24 cases(femsral head and neck;5, intertrochanteric;7, subtrochanteric;8, femoral shaft;4) and upper extremity in 8 cases(proximal humerus;2, humoral shaft;6). The method of surgery was excision of tumor mass and rigid internal fixation to allow immediate mobilization, except 2 cases of amputation. The results were analysed by two criteria. The first was the grade of performance status that was made by modification of Functional Classification of New York Heart Association. The second was the degree of pain relief. The performance status was improved at least one grade in all patients and the mean improvement was 1.7 grades. The satisfactory pain relief was achieved in 81% of patients. Postoperatively, most of the patients had only slight to moderate limitation of physical activities and they became comfortable at rest and ordinary activities. The solitary metastatic lesions showed better pain relief(92%) than multiple metastasis(75%). The curative surgery was done in 3 cases, and they showed more than 24 months of disease-free survival.

• Journal of Veterinary Clinics
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• v.25 no.6
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• pp.458-465
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• 2008

The purpose of this study is to characterize canine mesenchymal stem cells (MSCs) derived from bone marrow (BM) for use in research on the applications of stem cells in canine models of development, physiology, and disease. BM was harvested antemortem by aspiration from the greater tubercle of the humerus of 30 normal beagle dogs. Canine BM-derived MSCs were isolated according to methods developed for other species and were characterized based on their morphology, growth traits, cell-surface antigen profiles, differentiation repertoire, immunocytochemistry results, and neurotrophic factor expression in vitro. The canine MSCs exhibited a fibroblast-like morphology with a polygonal or spindle-shaped appearance and long processes; further, their cell-surface antigen profiles were similar to those of their counterparts in other species such as rodents and humans. The canine MSCs could differentiate into osteocytes and neurons on incubation with appropriate induction media. RT-PCR analysis revealed that these cells expressed NGF, bFGF, SDF-1, and VEGF. This study demonstrated that isolating canine MSCs from BM, stem-cell technology can be applied to a large variety of organ dysfunctions caused by degenerative diseases and injuries in dogs. Furthermore, our results indicated that canine MSCs constitutively secrete endogenous factors that enhance neurogenesis and angiogenesis. Therefore, these cells are potentially useful for treating dogs affected with various neurodegenerative diseases and spinal-cord injuries.

• The Journal of the Korean bone and joint tumor society
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• v.1 no.2
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• pp.189-193
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• 1995

The authors reviewed 49 cases(48 patients) of benign bone tumor who had surgical treatment with xenograft at department of orthopedic surgery, Seoul National University Hospital from May, 1980 to May, 1994. Materials consist of 21 males and 27 females. The mean age at operation was 20.1 years(range : 4 -55 years) and the mean follow up period was 25.4 months(range : 7 - 85 months). We did xenograft only in 34 cases and xenograft mixed with autograft in 15 cases(14 cases, from ilium, 1 case from femur). The used materials for xenograft were $Lubboc^{(R)}$ in 29 cases, $Surgibone^{(R)}$ in 17 cases and $Pyrost^{(R)}$ in 3 cases. The average durations when bony union was achieved in radiograph were 13.8 weeks in whole cases, 12.5 weeks(range : 8 - 24 weeks) in $Lubboc^{(R)}$ graft cases and 15.7 weeks(range : 6 - 24 weeks) in $Surgibone^{(R)}$ graft cases. The tumor recurred in 4 cases, 1 case was recurred giant cell tumor at distal femur treated with mixed auto and $Lubboc^{(R)}$ graft and 2 cases were large cystic lesions at the proximal humerus diagnosed as simple bone cyst and at distal tibia diagnosed as fibrous dysplasia treated with $Surgibone^{(R)}$ graft and 1 case was aneurysmal bone cyst of the proximal tibia treated with $Lubboc^{(R)}$ graft. Wound infection occurred in 1 case. More transfusion was done in the cases that the lesion was larger than 5cm, the lesions were in the ilium or femur and the cases that were treated with mixed with autograft. This study implies that benign bone tumor is successfully treqated with curettage and xenograft or xenograft mixed with autograft. And also this method will reduce morbidity of donor site, intraoperative bleeding and post-transfusion complications.

• Archives of Reconstructive Microsurgery
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• v.9 no.2
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• pp.139-146
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• 2000

The aim of this study was to assess whether the functional regeneration of a lyophilized autografted cartilage could be improved by implanting a vascularized muscle flap into the medullary canal of autografted proximal humerus. A hemijoint reconstruction using a lyophilized osteochondral autograft in proximal humerus was done in 4 rabbits for control, and combined with an vascularized intramedullary muscle flap in another 4 rabbits for the experimental group. Graft healing and the repair process of osteochondral graft were followed by serial radiographs and histologic changes for 9 weeks after experiments. Each two rabbits in control and in experimental group on 5th and 9th week after implantation of hemijoint were sacrified. The results were as follows: 1. All of control and experimental froups on 5th week united solidly on osteotomized site radiologically, but their articular cartilages were destroyed more seriously in the control than that in experimental group with muscle flap on 5th and 9th week after experiment... 2. Histochemically, the cartilage surface are completely destroyed and revealed with severe osteoarthritic changes on all cartilage layers in control, but cartilaginous erosions are mild to moderate and their arthritic changes are also mild with somewhat regeneration of chondrocytes on deep layers more prominetly on 9th week of the experimental group. 3. The amount of collagen and protenized matrix which was determined by Masson-Trichrome stain was markedly decreased that means the weakness of bony strength and low osteogenic potential in lyophilized cartilage. These results suggest that an intramedullary vascularized muscle flap can improve the functional results of lyophilized osteochondral autograft by providing both increased vascularity and populations of mesenchymal cells to initiate new bone formation on osteotomized site as well as the regeneration of deep layers in articular cartilage. In clinical relevances, this lyophilized hemijoint autograft combined with an intramedullary vascularized muscle pedicle graft might be used very effectively for the treatment of malignant long bone tumors to preserve the joint functions, all or partly, and so to replace it with the artificial joint after tumor excision and hemijoint autograft.

• Journal of Veterinary Clinics
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• v.30 no.3
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• pp.218-221
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• 2013

A flightless brown hawk owl (Ninox scutulata) weighing 180 g was rescued and referred to the teaching veterinary hospital with humerus open fracture. On physical examination and radiography, open fracture of the left humerus was found. After 3 days, orthopedic surgery was operated with intramedullary pins and wires. The bird died 2 days after surgery with anorexia. On necropsy, multiple green nodules with 2-3 mm in diameter were observed at the surface and inside of the left lung. Numerous conidial heads and spores were seen in the center of foci in the histopathological examination. The mycelia penetrated the surrounding pulmonary parenchyma, showing inflammation and necrosis. The fungus was isolated from the lung and cultured on Sabouraud Dextrose Agar at $30^{\circ}C$ for 7 days. The colony was blue-green color with a powdery surface. The fungus was identified as Aspergillus fumigatus by DNA analysis, including the internal transcribed spacer region, partial ${\beta}$-tubulin, and the calmodulin gene. This case was diagnosed as pulmonary aspergillosis secondary to open fracture of pneumatic bone in a brown hawk owl.

• Clinics in Shoulder and Elbow
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• v.16 no.1
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• pp.33-39
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• 2013

Purpose: The aim of this study is to evaluate the clinical result of intra-articular fractures of the distal humerus (AO type C) in elderly osteoporotic patients treated with double tension band osteosynthesis. Materials and Methods: From January 2006 to December 2010, 10 elderly osteoporotic patients(1 male, 9 females) with intra-articular fractures of the distal humerus (AO type C) were treated with double tension band osteosynthesis. The mean age of patients at the time of surgery was 74.6(66~84) years and the mean follow-up period was 39.2(20~74) months. The fracture union and complications were assessed and the functional result was evaluated by the rating system of Jupiter et al. and the Mayo elbow performance index. Results: Bone union was achieved in all patients with no secondary displacement. The mean time for union was 16.6(13~22) weeks. The average postoperative arc of elbow flexion was 119(100~140) degrees with a mean flexion contracture of 8.5(0~15) degrees. The recovery in two patients was rated as excellent, in 7 as good, and in 1 as fair in terms of the Mayo elbow performance index with average value of 82(70~90) points. Seven patients were rated as excellent, 1 as good, and 2 as fair in terms of the rating system of Jupiter et al. Changing tension band wiring was performed in one patient as skin irritation was noticed due to tension band knots. Heterotopic ossification developed in one patient but had no symptom. Conclusion: Double tension band osteosynthesis in intra-articular fractures of distal humerus (AO type C) in elderly osteoporotic patients can provide sufficient and secure stability to allow early rehabilitation.

• Clinics in Shoulder and Elbow
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• v.10 no.1
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• pp.112-123
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• 2007

Purpose: Evaluate the clinical results of humerus neck nonunion treated with Polarus intramedullary nail. Materials and Methods: 8 patients who underwent surgery for nonunion of humerus surgical neck fracture were included. All patients were female, the average age was 65 years. 5 out the total 8 cases initially received surgery, open reduction and internal fixation with metal plate in 1 case, Ender nail insertion in 2 cases, external fixator in 1 case and closed reduction and percutaneous pinning in 1 case. The other 3 non union cases initial received conservative managemnent. The average period of nonunion was 9 months in the operated group and 6.2 months in the conservative group. All 8 cases received closed reduction with intrameedullary Polarus nail and auto iliac bone graft. Union was confirmed radiologically, and functional evaluation was done with the UCLA functional criteria. Results: All 8 cases showed union on radiologic evaluation. Average time to union was 3.5 months, average follow up period was 27 months. Average UCLA shoulder evaluation score was 7.6 points preoperatively which improved to 26.3 points after surgery. Active shoulder flexion was 40.7 degrees preoperatiely which increased to 104 degrees after surgery. Shoulder abduction improved from 32.9 degrees preoperatively to 96.3 degrees after surgery. UCLA functional criteria was good in 5 cases and fair in 3 cases, which no poor cases. Conclusion: Polarus IM nailing and AIBG is a useful method for treating nonunion of humerus neck fracture with improvement in union and function.

• The Journal of Korean Orthopaedic Ultrasound Society
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• v.6 no.1
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• pp.1-9
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• 2013

Purpose: The purpose is to perform objective evaluation for rotator cuff using ultrasonography and validate factors influencing cuff integrity as well as efficacy of follow-up ultrasonography after unreamed antegrade intramedullary nailing for humerus fracture. Materials and Methods: Seventeen patients with an average age of $55.7{\pm}18.6$ years underwent antegrade intramedullary nailing for humerus fracture and follow-up ultrasonography of shoulder joint. Mean follow-up period was $43.5{\pm}32.2$ months. Intraoperative evaluation for preoperative cuff tear was performed, of which four cuffs were repaired by single row repair technique. Clinical evaluation included visual analogue scale (VAS), range of motion, Korean Shoulder Scoring System (KSS) and American Shoulder and Elbow Society (ASES) score. Ultrasonographic evaluation was performed on cuff integrity and protrusion of proximal nail tip as well. Radiographic evaluation included time to union, protrusion of proximal nail tip and migration of proximal interlocking screw which could affect shoulder joint function. Results: Mean VAS at last follow-up was $1.65{\pm}1.84$ points. Range of motion showed forward flexion of $137.0{\pm}33.5^{\circ}$, external rotation of $43.5{\pm}12.7^{\circ}$ and internal rotation of $16.4{\pm}2.0^{\circ}$ while KSS score and ASES score were $79.6{\pm}20.7$ and $83.7{\pm}17.0$ points, respectively. Bone union was demonstrated in all cases and average time to union was $3.4{\pm}1.3$ months. Migration of proximal interlocking screw was shown in 6 cases (35%). On ultrasonographic evaluation, there were normal in 8 (47%), weaving in 4 (24%), partial tear in 5 cases (29%), but no complete tear. Protrusion of proximal nail tip was demonstrated in 8 cases (47%) on plain radiographs whereas in 11 cases (65%) on ultrasonography and was associated with increasing age (p=0.038). Ultrasonographic weaving and partial tear was associated with protrusion of proximal nail tip (p=006), but not with repair of preoperative tear (p>0.05). Conclusion: Because weaving and partial tear on ultrasonography originated from protrusion of proximal nail tip, careful insertion of nail and meticulous repair of cuff during operation lead to stable fixation with satisfactory recovery of shoulder function follow-up ultrasonography can be a useful tool for evaluating protrusion of nail tip and rotator cuff tear, of which diagnosis is difficult on plain X-ray after antegrade intramedullary nailing for humerus fracture.